title: Variability of thinness and its relation to cardio-metabolic risk factors using four body mass index references in school-children from Delhi, India.
abstract: OBJECTIVE
  To compare: (i) prevalences of thinness in school-children by four body mass index references in common use viz., Centre for Disease Control (CDC); Cole; Indian Academy of Pediatrics (IAP); World Health Organization (WHO); and (ii) relationship of thinness with absence of cardio-metabolic risk factors in these BMI references.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Schools in Delhi.
  
  
  METHODS
  Anthropometry and blood pressure were measured in 16,245 school children aged 5 to 18 years. Fasting lipids and blood sugar were estimated in 2796 subjects.
  
  
  METHODS
  Age and sex-specific prevalences of thinness and predictive ability of reference cut-off for detecting any cardio-metabolic risk factor were compared.
  
  
  RESULTS
  Prevalence of thinness varied with the reference employed; more so for boys. Overall prevalence of thinness was least with IAP reference and highest with CDC cut-offs (6.6% to 16.9% in boys, 6.5% to 10.3% in girls). Children identified as thin by any reference had comparable, significantly lower risks (OR 0.59 to 0.73) of associated cardio-metabolic aberrations. In subjects with any cardio-metabolic or blood pressure aberration, the prevalence of thinness was highest with CDC and least with IAP definition.
  
  
  CONCLUSIONS
  Prevalence of thinness varies considerably with the reference employed. Thin children, identified by any reference, have a lower risk of associated cardio-metabolic aberrations; however, thinness is a poor diagnostic test for this purpose. In populations undergoing nutrition transition, there is a need to link cardio-metabolic risk factors with recommended anthropometric criteria to define undernutrition.
authors.affiliation: Department of Pediatrics and Clinical Epidemiology, Sitaram Bhrtia Institute of Science and Research, B 16, Qutab Institutional Area, New Delhi 110016, India; Departments of Human Nutrition and Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi 110029, India; Medical Research Council Lifecourse Epideiology Unit, University of Southampton, Southampton General Hospital, Southampton S016 6YD, UK; Current affiliation: Conjoint Associate Lecturer, School of Womens and Children Health, University of New South Wales and Department of Community Pediatrics, Liverpool Hospital, NSW, Australia; Current affiliation: Senior Programme Associate, Public Health Foundation of India (PHFI), Vasant Kunj, New Delhi 110070 and Current affiliation: Statistical Officer, Planning Department, Government of NCT of Delhi, New Delhi 110002. Correspondence to: Prof HPS Sachdev, Senior Consultant Pediatrics and Clinical Epidemiology, E 6/12, Vasant Vihar, New Delhi 110 057, India. hpssachdev@gmail.com.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.forename: Supreet
authors.initials: S
authors.lastname: Kaur
authors.forename: Dileep
authors.initials: D
authors.lastname: Gupta
authors.forename: Clive
authors.initials: C
authors.lastname: Osmond
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Lakshmy
authors.forename: Shikha
authors.initials: S
authors.lastname: Sinha
authors.forename: Umesh
authors.initials: U
authors.lastname: Kapil
authors.forename: H P S
authors.initials: HP
authors.lastname: Sachdev
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012016:Reference Values; D013851:Thinness / Q000453:epidemiology*